Provider Demographics
NPI:1457542144
Name:ANH T. PHAM, DDS, PC
Entity Type:Organization
Organization Name:ANH T. PHAM, DDS, PC
Other - Org Name:CHANTILLY GREEN DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANH
Authorized Official - Middle Name:TU
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-378-2466
Mailing Address - Street 1:13035 LEE JACKSON MEMORIAL HWY STE D
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2039
Mailing Address - Country:US
Mailing Address - Phone:703-378-2466
Mailing Address - Fax:703-378-2467
Practice Address - Street 1:13035 LEE JACKSON MEMORIAL HWY STE D
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2039
Practice Address - Country:US
Practice Address - Phone:703-378-2466
Practice Address - Fax:703-378-2467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410353122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty